Neurology | Brain health through prevention

Rehabilitation after a stroke: gripping movements are trained again. Photo: dpa/Patrick Pleul No longer recognizing your family, forgetting your address and no longer finding your way home, getting lost in time - that can cause dementia, and people in Germany are particularly afraid of that. Just like a stroke, which in many cases results in disability. Paralysis as well as swallowing and speaking disorders can occur, among other things.

What fuels the fear is the loss of brain health associated with the diseases. This means that learning, creativity, productivity and social participation are more difficult or no longer possible. But the risk of both diseases could be significantly reduced through prevention.

This gain in prevention is not new, but it is increasingly well documented. Neurologists have now drawn attention to this in connection with the congress of the German Society for Neurology in Berlin this week. There are several studies available, especially for strokes.

In two of the more recent ones, the influence of risk factors on the disease burden was a good 80 percent. The 2016 Interstroke study with participants from 32 countries showed that ten modifiable risk factors were associated with 90 percent of the risk of stroke. However, the results describe the prevention potential at population level, says DGN President Daniela Berg. This means, according to the neurologist from the University Hospital Schleswig-Holstein in Kiel, that the probability of preventing a stroke in individual cases is not described here.

The mentioned risks of a stroke include high blood pressure, lack of exercise, high blood lipid levels, smoking, diabetes mellitus, unhealthy diet, excessive alcohol consumption and atrial fibrillation. However, many of these factors also contribute to increasing the risk of cardiovascular diseases or cancer. So it can't be wrong to look into it and perhaps question one or two habits. The more medical risk factors should be under medical control.

“If you want prevention, you have to make it possible.”

But there remains something that can be described as individual “lifestyle dissonance”. Neurologist Berg and her team coined the term themselves: the gap between precise knowledge about a healthy lifestyle and everyday reality. If you follow the concept, health resolutions fail for biological reasons.

For Berg, it is therefore a matter of better understanding brain activity: “The brain needs time to learn. And it can also learn.” Human evolution has taught us that a high-energy diet was almost always necessary – and jogging was not. “If you want prevention, you have to make it possible,” says the neurologist and calls for political support for this. Because the reward system in the brain is faster and thinking takes longer, people need to be encouraged in prevention rather than just blaming them for wrong behavior.

But prevention is not just behavior that is intended to help prevent illness. In addition to this primary prevention, health scientists and doctors have introduced two further dimensions: Secondary prevention here means the early detection of diseases, which includes regular blood pressure measurements or early cancer detection using various procedures. Tertiary prevention attempts to minimize consequential damage or relapses in the case of existing illnesses - this can be done, among other things, in rehabilitation.

The latter area is important in stroke care. There are already 1.5 million people in Germany who have survived one; 70,000 patients are diagnosed every year with a new diagnosis. Götz Thomalla, neurologist and manager at Hamburg University Hospital Eppendorf, sees the problem here as being that there is still too little continuity in aftercare. "There are several contacts, many topics and several specialist disciplines and professions that are involved, as well as the division into sectors - hospitals, rehabilitation facilities and outpatient care."

What also makes a difference in aftercare is how actively patients (or relatives) can take care of the necessary therapies. In any case, when it comes to strokes, it is important to avoid further events of this type and not to neglect the psychological aspect of reducing the consequences.

Follow-up care is even more important as there is new evidence that inflammatory processes in the blood vessels increase after a stroke. This inflammation in the brain tissue itself could last for decades. They could lead to cognitive impairments – even dementia. Minimizing these processes would therefore be useful in preventing secondary diseases.

A new DGN campaign shows what this can look like in concrete terms: Prevention works. Not only was useful information about Parkinson's, dementia and stroke collected here, but patients also report on the progression of their illness.

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